Dispensing opticians’ Q&A from the ABDO webinar

ABDO webinar – 8 December 2020

Providing Optimal Eye Care for Children with a Learning Disability and/or Autism

Q&A responses by:

Lisa Donaldson, SeeAbility
Martyn Howlett, SeeAbility
Richard Everitt, NHS England
Debbie McGill, ABDO

SeeAbility & the new NHS Eye Care Service

SeeAbility have pioneered the provision of eye care services for students attending special schools and remain an influential partner in the implementation of the service. They continue to provide services in 7 schools across London.

However, NHS England and NHS Improvement have the responsibility for commissioning and delivering the service nationally through an appointed network of clinicians. DOs who are interested in becoming providers should contact NHS England and NHS Improvement at: england.specialschooleyecareservice@nhs.net

This service applies to all special schools in England.

We have produced a film describing how the service works specifically addressed to parents here which we recommend they view before the first appointment.

Additional learning material developed specifically for clinicians is available via the Health Education England online learning course to support eye care professionals working with children and young people with learning disabilities and/or autism in special schools here.

NHS England has produced three 10 minute information films about the service aimed at Clinicians, Schools and Parents. While there is overlapping material between them, they contain unique footage so there is value in watching all three. Links to these films are here:


plus an additional FAQ document is available from mailto:england.specialschooleyecareservice@nhs.net

In development is further supportive materials which will be accessible through a dedicated online landing page for the service which we will advise ABDO of when ready.

For the background to this service, SeeAbility have information about their existing service which is the model upon which the NHS service is based at www.seeability.org

In conjunction with NASEN, SeeAbility have produced a guide here on this subject. SeeAbility also have a range of downloadable resources here.

Schools & practices

The DOs role alongside the Optometrist comprises the Special School’s Eye Care Team delivering this service. One of its founding principles is delivering the service on-site at the school as a means to reduce the inequality in health services provision this cohort experience.

We envisage most providers to be engaged in this role, 1-2 days per week – this will vary by provider and by school. Applicants should share their availability with NHS England when applying.

As a guide, a population of 100 children equates roughly to one day a week in school term time for each clinician. All children are seen on the school premises.

On average, we expect 6-8 children to be seen in one day.

The service is competency based so either an optometrist or DO can provide any competencies they are qualified to.

Research has found that only 1 in 10 children with a learning disability and/or autism attend community practices so the service has been designed specifically as an alternative point of access.

The service will adopt an opt-out policy so our expectation is that most, if not all children will participate preventing the need for referrals.

Yes. This is a brand new service and the dispensing optician has a fundamental role to play within the eye care team.

As we understand, this exemplary project is screening only for 4-5 year olds but ensuring there is a full eye exam and 2 pairs of glasses, with support with glasses wear from teaching staff.

In mainstream schools, around 10% of children fail screening so would be referred on to have a full test.

The NHS service is different because 99% of 4-5 year old children in a Special School fail standard vision screening and 50% have a problem. Therefore, this service enables all children to have a full eye test every year (not just at school entry).

Locational & service implementation

NHS England and NHS Improvement is responsible for commissioning services in England only, so this service will not be available in the other nations.

Other nations may be considering eye care services for children attending special schools, but we are not aware of an equivalent service currently being commissioned by them.

During the development this new service, NHS England approached and spoke to the subject matter leads in each of the other 3 nations. Due to their different health care systems and commissioning arrangements, it is possible they may need to deliver and fund the service in a different way to NHS England.

The pace at which this national service can be implemented across the country will be determined in part by the willingness of schools to embrace the service and the availability of clinicians to provide it. However, our expectation is that we will have national coverage (even if not in every school) within 5 years.

We are working with other organisations including the National Association of Special Schools (NASS) and the Department for Education (DfE) to ensure we reach all special schools across England. We also hope ‘word of mouth’ will help us to reach schools we may not be aware of.

CCGs are responsible for commissioning Secondary Care services delivered by Orthoptists and Ophthalmologists, both of whom are able to enhance or compliment this service by providing additional eye care services such as visual assessments. NHS England’s service has been designed to work alongside existing services that may already be available in special schools as long as current funding streams are maintained for secondary care clinicians.

Fees and vouchers

As there is a standard £116 fee per student appointment, please advise how it covers:

We are not using the GOS voucher system for the special school eye care service. Providers will instead be reimbursed at cost for the provision of frames and lenses to ensure that every child receives the most appropriate prescription/frames for their particular needs without financial constraints.

As above.

As above.

We anticipate spectacles being purchased through the recognised suppliers of specialist frames.

As above.

Payment for repairs and replacements will cover the cost of all materials. The service element of the dispensing service, ie. the cost of the clinician’s time, is covered by the sight test fee.

Frames & lenses

You would need to set up accounts with the manufacturers/order a fitting set. Support is available via NHS England to fund start-up costs.

Based on SeeAbility’s model, we recommend using a combination of Tomato, SwissFlex, Continental, Miraflex, and Erins World.

If a child is clinically photophobic, transitions or 75% tint sunglasses. Trivex may be used in children who are at high risk, eg. self injurious behaviour/head banging and also in thin Swissflex frames or a Miraflex. As a rough guide for higher Rxs, we use 1.6 or 1.7 with higher Rxs / 1.74 over -10.

It is better to wear glasses or goggles for swimming rather than taking them off. This encourages confidence and better mobility in the water by having better sensory input. Swimming goggles could be privately ordered.

* Student diagnosed as -6.00DS for the first time at age 14.

We started with a -4.00, partly in case the student also had reduced accommodation – we didn’t want to make near vision difficult, as it was a challenge to assess accommodation initially. After a few weeks, we increased to the full Rx.

There is no evidence base for best practice in this area so it relies on ‘clinical judgement’. SeeAbility advises that they often base Rxing decisions on dry/ functional retinoscopy, so if +6 is constantly manifest, for example, the full Rx will be given initially because the child is obviously not accommodating to overcome. With high cylinders, there can be a slight reduction initially to aid adaption.

Assuming normal posture, at the bottom of the pupil.

If postural challenges are significant, it would likely be better to have separate pairs – similarly, if there are significant issues with head control.

It is always best to take measurements when the child is in a habitual position, ie. don’t hold or adjust the head to take any measurements.

How can I get involved?

Details on how to apply are in the ABDO Website Professional Toolbox.
When NHS England receive an enquiry, we will ask for particular details so that interest is registered.

An additional FAQ sheet can be requested from england.specialschooleyecareservice@nhs.net

The 10 minute film is available within the Professional Toolbox on the ABDO website and also referenced in the SeeAbility & the new NHS Eye Care Service section.

Yes, we aim to ‘match’ clinicians to interested schools according to locality.